Overview of Aetna plans available on Arizona exchange (also called "marketplace")

This plan’s provider network is in Maricopa and Pinal counties. If you receive care from providers outside of the network, you will be covered at the out-of-network benefits level, resulting in greater member costs.

You can shop for and buy health insurance on your state exchange. Exchanges can help you choose a plan that fits your needs and budget.

You can also compare plans using a document called the Summary of Benefits and Coverage (SBC). It provides an overview of each medical plan in a standard format, in easy-to-understand language. The SBC documents for Aetna plans available in Arizona are listed below.

Once you're enrolled, we'll send you a copy of the SBC for the plan you picked. The SBC will also include the date your plan takes effect.

Picking the plan that’s right for you

It's important to choose a plan that will meet your needs. The information below can help you narrow your choices:

1. Check our online directories to find out if your doctor and pharmacy are in our network.

Ready to enroll?

The next open enrollment period begins November 15, 2014, and runs through February 15, 2015. If you have had a life-changing event, you may be able to enroll outside of the open enrollment period. If you have questions or need help with enrolling, call the Arizona exchange at 1-800-318-2596.

Summary of Benefits and Coverage (SBC) documents for exchange plans available in Arizona

The Summary of Benefits and Coverage (SBC) is designed to help you understand and compare different medical plan options.

The "Standard" category is where most consumers will find their available plans. In some cases, you will also see plan names that reflect unique provider arrangements, like Aetna Banner Health.

However, the Arizona exchange may have indicated you are eligible for a Cost-Sharing Reduction (CSR) plan or a Native American (NA) plan. This is based on the information you shared when you applied for insurance. If so, refer to those sections when looking at the plans below.

Here are some quick definitions:

Abbreviation

What it means

Number shown in plan name

Deductible amount for the standard plan (for example, Aetna Classic 5000 has a $5,000 deductible). Based on eligibility, the deductible for a CSR or NA plan may vary from the standard plan deductible. For most plan benefits, you must meet the deductible before you will begin to split the cost of care with your health plan.

PD

Includes coverage for pediatric dental (covered to age 19).

CSR 73%

With cost-sharing reduction, the percentage of average costs the plan will pay increases to 73%.

CSR 87%

With cost-sharing reduction, the percentage of average costs the plan will pay increases to 87%.

CSR 94%

With cost-sharing reduction, the percentage of average costs the plan will pay increases to 94%.

NA CSR $0

For this Native American plan, there is no cost-sharing in or out of network for the member; for all benefits, you pay nothing out of pocket for covered services.

NA CSR LTD

For this Native American plan, you pay nothing for covered services furnished directly to you by the Indian Health Service, an Indian Tribe, Tribal Organization, Urban Indian Organization or through referral under-contract health services. This includes deductibles, coinsurance and copayments.

About the Metallic LevelsHealth insurance plans sold on an exchange are assigned a metallic level (Bronze, Silver, Gold, or Catastrophic). The metallic level is based on how much of the total health care cost the plan pays, versus what a member will pay out of pocket.

Bronze plans

For Bronze level plans, the plan will pay about 60 percent of covered health care costs. Bronze plans tend to have lower monthly premiums, but have higher out-of-pocket costs for deductibles, copayments and coinsurance for covered health care services.

Catastrophic plans

Catastrophic plans generally have lower monthly payments and recommended preventive services are covered at 100 percent. Catastrophic plans are only available to individuals not yet age 30, or individuals for whom insurance is determined to be unaffordable as evidenced by a hardship exemption.

What forms of payment does Aetna accept?

Please Note: Under Aetna health insurance policies in some states, we do not generally accept premium payments from third parties, unless they are related to you or required by law. Examples of third parties we do not accept payment from include (but are not limited to) hospitals and health care providers.

How can I make my monthly payment?

We offer several options to make your monthly premium payment. You can:

Log in to your Aetna Navigator® secure member website and pay online.

Use EasyPay. We will automatically withdraw your payment from your checking account on the due date.

Send your payment by mail. Make sure to include key information from your billing invoice.

When is my premium due each month?

Premium payments are due the first of the month.

Health insurance plans are offered and/or underwritten by Aetna Life Insurance Company (Aetna).

This material is for information only. Health benefits and health insurance contain exclusions and limitations. Not all health services are covered. See plan documents for a complete description of benefits, limitations, exclusions and conditions of coverage. Plan features and availability may vary by location. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Investment services are independently offered by HealthEquity, Inc.. Information is believed to be accurate as of the production date; however, it is subject to change.

Investment services are independently offered by the HSA Administrator.

We're here to support you

On the phone:

Once you've enrolled, you can reach us by calling the number on your Aetna ID card.

Or, call 1-855-586-69608 a.m.-6 p.m. local time, Monday through Friday.

Do you have a certified speech or hearing disability?
Call 711 and we'll help you.

Do you need help in another language?
Our Member Services representatives can connect you to a special line. You can talk to someone in your own language, receive oral interpretation and request written translations of documents into another language.

Online:

If you're not a member or if you prefer not to log in, e-mail us. We'll need your personal and contact information so we can get back to you. We respond to messages from 8 a.m.-6 p.m. (ET), Monday-Friday.

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